Thyroid Strong

Have you ever had joint pain, especially knee pain, which comes and goes without any rhyme or reason? You’ve noticed there may have been no official injurious event, such as stepping off a curb wrongly, twisting your knee, or pushing yourself too hard at the gym. There seems to be no logical mechanism of injury (MOI) for your pain but your joints simply ache. 

As a result, it can be extremely frustrating to understand the root cause and address it correctly, especially if this type of pain is poorly understood in conventional medicine. In this article, I’ll explain why women with Hashimoto’s struggle with joint pain and share solutions that actually work based on both my personal and clinical experience.

Why does Hashimoto’s hypothyroidism cause joint pain?


Hashimoto’s and low thyroid function reduce the turnover and regeneration of tendons, which is why they hurt [1]. It also slows down joint healing, causing inflammation. When you step down a stair, the quadriceps muscle lengthens and pulls on the knee cap, putting a load on the infrapatellar tendon. This can cause knee pain, especially if you already have loose and inflamed joints.  


Unique ways joint pains present with Hashimoto’s


Clinically, I’ve observed that women with Hashimoto’s tend to struggle with pain in their extremities such as knees, hands and feet, shoulders, and hips. The pain severity often correlates with other common symptoms of Hashimoto’s, including but not limited to: anxiety, weight gain, gastrointestinal issues, mood swings, fatigue, depression, cold hands and feet, and brain fog.

Knee pain while going up and down the stairs is very common among women with Hashimoto’s. Sometimes, I find that they have such severe knee pain that even putting slight pressure on the knees can cause a flare-up. They even avoid getting down on the floor for fear of not being able to get up again. Does this sound like you?

The joint pain can come and go, or move around the body because it’s a sign of systemic (whole body) inflammation. You may feel muscle tension, tenderness, and stiffness. Joint pain occurs throughout the extremities, such as:

  • Knees
  • Elbows
  • Hips
  • Shoulders
  • Hands and finger joints. Carpal tunnel syndrome is also very common among women with Hashimoto’s.

Because Hashimoto’s slows down joint healing and increases inflammation, you may experience joint effusion or fluid buildup in the joints, especially in the knees. Effusion can make the knee feel like the following:

  • As if it’s floating
  • Unstable
  • Stiff
  • Has a limited range of motion in a deep knee bend (flexion) or full knee straightening (extension)
  • Locked when getting up from sitting


How to check for knee swelling in Hashimoto’s

Unsure if you have swelling in your knees and want to test for this on your own? These are simple orthopedic tests used by orthopedic specialists but can be easily replicated at home. These 2 tests are:


THE BULGE TEST

Sweep your hand up the inside of your knee, then sweep your hand along the outside of the knee down towards your shin. As you sweep down the outside of your knee, if a bulge of fluid appears on the inside of your knee, there is synovial fluid build-up in the knee joint. This means that the knee joint is inflamed.


THE BAKER’S CYST CHECK

Feel the back of your knee and compare it to your other knee. You may feel a lump, like a water-filled balloon, behind the knee that becomes more obvious when the knee is straight. While this is not a medical term, a feeling of “bogginess” behind the knee is what I often describe to patients. Women with Hashimoto’s, in my clinical experience, will have knee pain in both knees but swelling tends to be more significant in one than the other.

How Hypermobility can cause Joint Pain with Hashimoto’s


A 2019 clinical study found that hypermobile joints are more common among hypothyroid patients [2]. This is consistent with my clinical observations. The increased range of joint motion and often abnormally wide adds another layer to the pain picture. When the joints, and especially the knees, are hypermobile, muscles around the knee will feel tight because they are trying to hold the unstable joint together.

To make matters worse, Hashimoto’s can lead to muscle mass loss and difficulty maintaining muscle mass because thyroid hormones are important for muscles [3]. As a result, you have less muscle to stabilize your loose joints. So, with a tendency towards low muscle mass and a possibility of hypermobile joints, it’s understandable that knee pain is very common among women with Hashimoto’s.

A hypermobile knee can drive into too much extension and also rotate inwards as if the knee caps are wanting to look at each other. Most women already have weak gluteal (butt) muscles that counteract this rotation, allowing the knees to rotate. As a result, the muscles around the knees, such as the popliteus and the IT bands, become strained. The popliteus is a small band of connective tissue around the outside corner of your knees, whereas your IT band runs from the hip to the outside of each knee. When both of these connective bands are strained, the outside of your knees will hurt [4]. The popliteus also gets overworked at the end range of extension, adding to the soreness.

Another muscle often overworked with hypermobile knees is the IT band which also creates pain on the outside of the knee. The strain on both the popliteus and IT band  muscles can be tremendously painful, especially compounded with inflammation and slow healing from low thyroid. Keep in mind that rehabilitation of the knees without treating the thyroid tends to be a long road with minimal results. 

How to Heal Joint Pain from Hashimoto’s


Now that you understand the root causes and presentation of Hashimoto’s joint pain, here I will empower you with the steps to heal from Hashimoto’s joint pain.

Step 1: Get your Hashimoto’s and inflammation under control


Since the joint pain arises from Hashimoto’s, you need to get your Hashimoto’s–both low thyroid function and inflammation–under control. The treatment is thyroid hormone replacement, such as levothyroxine or cytomel, which can restore your joint and tendon healing to normal levels. However, replacing the lost thyroid hormones doesn’t fix inflammation or autoimmunity. This is why I include a guide on an inflammatory diet in my Thyroid Strong program. I also recommend seeing a functional medicine or naturopathic doctor to address the root causes and triggers of the inflammation.


Step 2: Use preventative rehab exercises and neural priming to warm up


When you have joint pain, stiffness, or visible swelling, what do you do?  The pain can tempt you to stay on the couch or stick to gentle and stretchy exercises, but these are working against your goals to eliminate the pain.

Like many other types of chronic pain, joint pain sometimes has very little to do with the actual damage. Instead, it’s mainly a way for your body to protect itself. It does this by saying: “Hey, I’m scared this will break, so please don’t move.” Therefore, the key to managing chronic pain when there is no logical cause of damage is to make your body feel safe. 

First, it starts with some movement despite the pain, such as with a warm-up or preventative rehab exercises before strength training to strengthen your joints. This pre-hab is strategic in warming up the body with the breath, turning on the core with a brace, and moving the body in all three planes of motion since so much of our day is stagnant in one plane of motion.

I prefer a warm-up that taps into the part of the brain which stores our movement patterns similar to the patterns we learned during the first two years of life. We didn’t walk before we learned to crawl, and we didn’t crawl before we learned to bring our knees up to 90 degrees. A solid pre-hab warm-up should mimic our developmental patterns to prime the brain to get ready to lift.

Once you prime your nervous system and gently tell your body that it’s safe to move, you’ll be ready to start lifting weights.

It’s counterintuitive to be squatting and lifting heavy weights when your knees hurt, but trust me that strength is what your body needs to feel safe.


Step 3: Strength training


A 2015 study showed that just one hour of
exercise each day improved thyroid function of patients with treated hypothyroid compared to those who did not exercise at all. The exercises prescribed in this study were running and/or playing sports, but I think the choice of exercise can be done with even more intentionality and strategy.

I recommend an exercise routine that focuses on maintaining strong muscles to help support and protect your joints, promotes a healthy range of motion of your joints, and boosts your energy.

I define strength training as physically picking up a weight, such as a kettlebell with the correct form, putting it down and doing it again and again. This helps stabilize those hypermobile joints as well. I’m not referring to bicep curls, tricep dips, and lateral deltoid raises. Instead, I’m referencing the Essential Seven compound movements aka full bodywork as opposed to a single muscle group, such as:

  • Squats
  • Lunges
  • Deadlifts
  • Push 
  • Pull
  • Carry
  • Anti-rotation

Step 4: Meditation for chronic pain relief with Hashimoto’s


Chronic pain
happens when your brain learns to sense the pain [5]. The pain sensation is also tightly tied to chronic stress. Therefore, medication and any stress management practices will be helpful. 

Meditation doesn’t have to look like a monk on top of a mountain sitting cross-legged. Try sitting in a comfortable chair or lying on your back. Chronic pain is stressful and studies show that mindfulness meditation may help reduce sensitivity to pain [6].

One of my favorite schools of meditation comes from Emily Fletcher’s Ziva Meditation. It’s geared for everyday people who live busy lives, not for monks or people who are already good at meditation.

 

Step 5: Use supplements to relieve pain from Hashimoto’s


If you’re taking non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen for your pain, you should be careful. Over-the-counter medications are effective at reducing inflammation in the short run, but they won’t get to the root cause, and the joint pain, especially in the knee will eventually return. Worse yet, NSAIDs can prevent
tendon healing and further damage the cartilage [7,8] which already heal slowly with Hashimoto’s. They also damage the gut barrier, further contributing to autoimmunity and inflammation in the long run [9]. Therefore, supplements can be the safer and more effective option.

I’ve found the following supplements to be helpful for Hashimoto’s joint pain both for myself and my Thyroid Strong students. You should consult your functional medicine doctor regarding the supplements that will be the most beneficial for you and how to take them. 

Magnesium

Magnesium can provide relief for muscle discomfort. I used magnesium in two different ways:

  • Epsom salt baths
  • An oral combination of magnesium citrate, magnesium glycinate, and magnesium malate.

Fish oils

Omega 3 fatty acids, in particular, promote a balanced inflammatory response. One study showed Omega 3 to be beneficial for neck, back, and arthritic pain [10].

Turmeric

The women I’ve seen with Hashimoto’s swear by their turmeric supplements to manage their joint discomfort. Turmeric balances neuronal signals and excess inflammation that contribute to pain [11]. Unlike NSAIDs, turmeric supports tendon healing and doesn’t wear down the cartilage [12,13].

Conclusion: Managing and Healing Hashimoto’s Joint Pain


Ladies, joint pain with Hashimoto’s doesn’t have to be a lifelong struggle. Try the recommended movements, supplements, meditation, and let me know how you feel. My hope is for the pain you feel the next time you kneel on the floor to become a distant memory.

I hope you can chase your kids upstairs without fear and live a pain-free life. For a comprehensive exercise program to eliminate pain and strengthen your joints, check out Thyroid Strong, the only online exercise program for women living with Hashimoto’s. Having put my own Hashimoto’s into remission by cleaning up my diet and strength training, I now help fellow women with Hashimoto’s live pain-free using the same approach.

 

In Good Health,
Dr Emily Kiberd

The 3 Biggest Workout Mistakes You May Be Making with Hashimoto's

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References:

1 Oliva, F., Berardi, A. C., Misiti, S. and Maffulli, N. (2013) Thyroid hormones and tendon: current views and future perspectives. Concise review. Muscles Ligaments Tendons J 3, 201–203.

2 Bilgic Dagci, A. O., Rapaport, S. and Lew, L. Q. (2019) Association Between Thyroid Autoimmunity and Joint Hypermobility in Children and Adolescents. MediSys Research.

3 Villar, J., Finol, H. J., Torres, S. H. and Roschman-González, A. (2015) Myopathy in patients with Hashimoto’s disease. Invest. Clin. 56, 33–46.

4 Nyland, J., Lachman, N., Kocabey, Y., Brosky, J., Altun, R. and Caborn, D. (2005) Anatomy, function, and rehabilitation of the popliteus musculotendinous complex. J. Orthop. Sports Phys. Ther. 35, 165–179.

5 Crofford, L. J. (2015) Chronic Pain: Where the Body Meets the Brain. Trans. Am. Clin. Climatol. Assoc. 126, 167–183.

6 Zeidan, F. and Vago, D. R. (2016) Mindfulness meditation-based pain relief: a mechanistic account. Ann. N. Y. Acad. Sci. 1373, 114–127.

7 Connizzo, B. K., Yannascoli, S. M., Tucker, J. J., Caro, A. C., Riggin, C. N., Mauck, R. L., Soslowsky, L. J., Steinberg, D. R. and Bernstein, J. (2014) The detrimental effects of systemic Ibuprofen delivery on tendon healing are time-dependent. Clin. Orthop. Relat. Res. 472, 2433–2439.

8 Shield, M. J. (1993) Anti-inflammatory drugs and their effects on cartilage synthesis and renal function. Eur. J. Rheumatol. Inflamm. 13, 7–16.

9 Bhatt, A. P., Gunasekara, D. B., Speer, J., Reed, M. I., Peña, A. N., Midkiff, B. R., Magness, S. T., Bultman, S. J., Allbritton, N. L. and Redinbo, M. R. (2018) Nonsteroidal Anti-Inflammatory Drug-Induced Leaky Gut Modeled Using Polarized Monolayers of Primary Human Intestinal Epithelial Cells. ACS Infect Dis 4, 46–52.

10 Maroon, J. C. and Bost, J. W. (2006) Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg. Neurol. 65, 326–331.

11 Kapoor, S. (2012) Curcumin and its emerging role in pain modulation and pain management. Korean J. Pain 25, 202–203.

12 Jiang, D., Gao, P., Lin, H. and Geng, H. (2016) Curcumin improves tendon healing in rats: a histological, biochemical, and functional evaluation. Connect. Tissue Res. 57, 20–27.

13 Akuri, M. C., Barion, M. R., Barbalho, S. M. and Guiguer, É. L. (2018) Alternative Therapeutic Approach for Cartilage Repair. Cartilage Repair and Regeneration, BoD–Books on Demand 43–55.

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